In this series of blog posts I’ve been summarising some myths and misconceptions around back pain. We’ve seen that things commonly thought to lead to bad backs like poor posture, spinal deviations, too much sitting, lifting or twisting and carrying heavy school bags if you’re a child are not especially dangerous at all. Further, the evidence is apparently telling us that protective behaviours people with back pain often adopt, like avoidance of exercise or particular movements, resting in bed and adopting altered postures are not helpful and may make matters worse.​

So what about when we try to do something to ease back pain, are there myths and misconceptions here too? Yes, there are.

A lot of this stems from an incomplete understanding of just what pain is. What it isn’t is just damaged tissues telling us that something is wrong. In fact, pain and tissue damage aren’t that closely connected. It turns out that pain is a highly personal experience coloured by each individual’s particular circumstances – their previous history with pain, their capacity to tolerate stress, their hopes, fears and expectations.

These things play a big role in back pain. So if all we do to relieve the pain is seek treatment from someone who focuses entirely on our tissue – bones, ligaments, muscles – then we shouldn’t be too surprised when relief is temporary at best in many cases. In fact, the feelings of anxiety and despondency people feel when they go from therapist to therapist looking for a silver bullet cure for their back pain without success even help to make things worse because they feed into the non-physical factors listed above.

As a manual therapist, I share the view that physical interventions work by breaking a pattern of distress which provides a window of opportunity for the nervous system to “re-set”. This may happen spontaneously but often will require additional measures to calm over-sensitised pain centres. These measures could include exercise, stress reduction, better sleep patterns, and enjoyable activities.

“Huh!” I can hear people say. “Exercise is the last thing you want to do when your back hurts. How can you meditate or concentrate on deep breathing when you’re in pain? Ditto, for getting a good night’s sleep. And as for having fun, forget it when you have a bad back!”

Well, yes. But this is why persistent pain persists. The very things we need to do to regain some measure of control over our pain are so difficult.

I know I keep banging on about this but it needs to be understood and accepted: pain almost always doesn’t equal damage, especially when it comes to backs.

That means that movement, exercise, and all the other beneficial things your body seems to be telling you not to do are, in fact, safe, aren’t going to make the situation worse.

Taking this idea on board is a vital first step. Then it’s a matter of working out a program which suits your particular circumstances. Almost any exercise is beneficial when it comes to back pain according to the latest research, so you can just pick one you enjoy, can afford and find convenient. Similarly, there are plenty of self-help measures to lift your spirits, lower stress and improve sleep. Maybe you’ll need to seek help to find the ones that work best for you but there IS a way forward.